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Lennartz S, Zopfs D, Große Hokamp N. Dual-energy CT revisited: a focused review of clinical use cases. ROFO-FORTSCHR RONTG 2024; 196:794-806. [PMID: 38176436 DOI: 10.1055/a-2203-2945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Jeph S, Gupta S, Yedururi S, Daoud TE, Stanietzky N, Morani AC. Liver Imaging in Gastroenteropancreatic Neuroendocrine Neoplasms. J Comput Assist Tomogr 2024; 48:577-587. [PMID: 38438332 DOI: 10.1097/rct.0000000000001576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
ABSTRACT The incidence of neuroendocrine neoplasms (NENs) has gradually increased over the past few decades with the majority of patients presenting with metastases on initial presentation. The liver is the most common site of initial metastatic disease, and the presence of liver metastasis is an independent prognostic factor associated with a negative outcome. Because NENs are heterogenous neoplasms with variable differentiation, grading, and risk of grade transformation over time, accurate diagnosis and management of neuroendocrine liver lesions are both important and challenging. This is particularly so with the multiple liver-directed treatment options available. In this review article, we discuss the diagnosis, treatment, and response evaluation of NEN liver metastases.
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Affiliation(s)
- Sunil Jeph
- From the Department of Radiology, Penn State University, Hershey, PA
| | - Shiva Gupta
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sireesha Yedururi
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Taher E Daoud
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nir Stanietzky
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ajaykumar C Morani
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Liu LP, Shapira N, Halliburton SS, Meyer S, Perkins A, Litt HI, Kauczor HU, Leiner T, Stiller W, Noël PB. Spectral performance evaluation of a second-generation spectral detector CT. J Appl Clin Med Phys 2024; 25:e14300. [PMID: 38386967 PMCID: PMC11005977 DOI: 10.1002/acm2.14300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE The aim of this study was to characterize a second-generation wide-detector dual-layer spectral computed tomography (CT) system for material quantification accuracy, acquisition parameter and patient size dependencies, and tissue characterization capabilities. METHODS A phantom with multiple tissue-mimicking and material-specific inserts was scanned with a dual-layer spectral detector CT using different tube voltages, collimation widths, radiation dose levels, and size configurations. Accuracy of iodine density maps and virtual monoenergetic images (MonoE) were investigated. Additionally, differences between conventional and MonoE 70 keV images were calculated to evaluate acquisition parameter and patient size dependencies. To demonstrate material quantification and differentiation, liver-mimicking inserts with adipose and iron were analyzed with a two-base decomposition utilizing MonoE 50 and 150 keV, and root mean square error (RMSE) for adipose and iron content was reported. RESULTS Measured inserts exhibited quantitative accuracy across a wide range of MonoE levels. MonoE 70 keV images demonstrated reduced dependence compared to conventional images for phantom size (1 vs. 27 HU) and acquisition parameters, particularly tube voltage (4 vs. 37 HU). Iodine density quantification was successful with errors ranging from -0.58 to 0.44 mg/mL. Similarly, inserts with different amounts of adipose and iron were differentiated, and the small deviation in values within inserts corresponded to a RMSE of 3.49 ± 1.76% and 1.67 ± 0.84 mg/mL for adipose and iron content, respectively. CONCLUSION The second-generation dual-layer CT enables acquisition of quantitatively accurate spectral data without compromises from differences in patient size and acquisition parameters.
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Affiliation(s)
- Leening P. Liu
- Department of RadiologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Nadav Shapira
- Department of RadiologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Sebastian Meyer
- Department of RadiologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Harold I. Litt
- Department of RadiologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Hans Ulrich Kauczor
- Diagnostic and Interventional Radiology (DIR)Heidelberg University HospitalHeidelbergGermany
| | - Tim Leiner
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
| | - Wolfram Stiller
- Diagnostic and Interventional Radiology (DIR)Heidelberg University HospitalHeidelbergGermany
| | - Peter B. Noël
- Department of RadiologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Yel I, D'Angelo T, Gruenewald LD, Koch V, Golbach R, Mahmoudi S, Ascenti G, Blandino A, Vogl TJ, Booz C, Bucolo GM. Dual-Energy CT Material Decomposition: The Value in the Detection of Lymph Node Metastasis from Breast Cancer. Diagnostics (Basel) 2024; 14:466. [PMID: 38472939 DOI: 10.3390/diagnostics14050466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To evaluate the diagnostic performance of a dual-energy computed tomography (DECT)-based material decomposition algorithm for iodine quantification and fat fraction analysis to detect lymph node metastases in breast cancer patients. MATERIALS AND METHODS 30 female patients (mean age, 63.12 ± 14.2 years) diagnosed with breast cancer who underwent pre-operative chest DECT were included. To establish a reference standard, the study correlated histologic repots after lymphadenectomy or confirming metastasis in previous/follow-up examinations. Iodine concentration and fat fraction were determined through region-of-interest measurements on venous DECT iodine maps. Receiver operating characteristic curve analysis was conducted to identify the optimal threshold for differentiating between metastatic and non-metastatic lymph nodes. RESULTS A total of 168 lymph nodes were evaluated, divided into axillary (metastatic: 46, normal: 101) and intramammary (metastatic: 10, normal: 11). DECT-based fat fraction values exhibited significant differences between metastatic (9.56 ± 6.20%) and non-metastatic lymph nodes (41.52 ± 19.97%) (p < 0.0001). Absolute iodine concentrations showed no significant differences (2.25 ± 0.97 mg/mL vs. 2.08 ± 0.97 mg/mL) (p = 0.7999). The optimal fat fraction threshold for diagnosing metastatic lymph nodes was determined to be 17.75%, offering a sensitivity of 98% and a specificity of 94%. CONCLUSIONS DECT fat fraction analysis emerges as a promising method for identifying metastatic lymph nodes, overcoming the morpho-volumetric limitations of conventional CT regarding lymph node assessment. This innovative approach holds potential for improving pre-operative lymph node evaluation in breast cancer patients, offering enhanced diagnostic accuracy.
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Affiliation(s)
- Ibrahim Yel
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Leon D Gruenewald
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Vitali Koch
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Rejane Golbach
- Institute of Biostatistics and Mathematical Modelling, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Scherwin Mahmoudi
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Thomas J Vogl
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Christian Booz
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Giuseppe M Bucolo
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
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Winkelmann MT, Gassenmaier S, Walter SS, Artzner C, Nikolaou K, Bongers MN. Differentiation of Hamartomas and Malignant Lung Tumors in Single-Phased Dual-Energy Computed Tomography. Tomography 2024; 10:255-265. [PMID: 38393288 PMCID: PMC10892507 DOI: 10.3390/tomography10020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
This study investigated the efficacy of single-phase dual-energy CT (DECT) in differentiating pulmonary hamartomas from malignant lung lesions using virtual non-contrast (VNC), iodine, and fat quantification. Forty-six patients with 47 pulmonary lesions (mean age: 65.2 ± 12.1 years; hamartomas-to-malignant lesions = 22:25; male: 67%) underwent portal venous DECT using histology, PET-CT and follow-up CTs as a reference. Quantitative parameters such as VNC, fat fraction, iodine density and CT mixed values were statistically analyzed. Significant differences were found in fat fractions (hamartomas: 48.9%; malignancies: 22.9%; p ≤ 0.0001) and VNC HU values (hamartomas: -20.5 HU; malignancies: 17.8 HU; p ≤ 0.0001), with hamartomas having higher fat content and lower VNC HU values than malignancies. CT mixed values also differed significantly (p ≤ 0.0001), but iodine density showed no significant differences. ROC analysis favored the fat fraction (AUC = 96.4%; sensitivity: 100%) over the VNC, CT mixed value and iodine density for differentiation. The study concludes that the DECT-based fat fraction is superior to the single-energy CT in differentiating between incidental pulmonary hamartomas and malignant lesions, while post-contrast iodine density is ineffective for differentiation.
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Affiliation(s)
- Moritz T. Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany; (S.G.); (S.S.W.); (C.A.); (K.N.); (M.N.B.)
| | - Sebastian Gassenmaier
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany; (S.G.); (S.S.W.); (C.A.); (K.N.); (M.N.B.)
| | - Sven S. Walter
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany; (S.G.); (S.S.W.); (C.A.); (K.N.); (M.N.B.)
| | - Christoph Artzner
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany; (S.G.); (S.S.W.); (C.A.); (K.N.); (M.N.B.)
- Institute of Radiology: Diakonie Klinikum Stuttgart, 70174 Stuttgart, Germany
| | - Konstantin Nikolaou
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany; (S.G.); (S.S.W.); (C.A.); (K.N.); (M.N.B.)
| | - Malte N. Bongers
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany; (S.G.); (S.S.W.); (C.A.); (K.N.); (M.N.B.)
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Hu X, Shi S, Wang Y, Yuan J, Chen M, Wei L, Deng W, Feng ST, Peng Z, Luo Y. Dual-energy CT improves differentiation of non-hypervascular pancreatic neuroendocrine neoplasms from CA 19-9-negative pancreatic ductal adenocarcinomas. LA RADIOLOGIA MEDICA 2024; 129:1-13. [PMID: 37861978 DOI: 10.1007/s11547-023-01733-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE To evaluate the utility of dual-energy CT (DECT) in differentiating non-hypervascular pancreatic neuroendocrine neoplasms (PNENs) from pancreatic ductal adenocarcinomas (PDACs) with negative carbohydrate antigen 19-9 (CA 19-9). METHODS This retrospective study included 26 and 39 patients with pathologically confirmed non-hypervascular PNENs and CA 19-9-negative PDACs, respectively, who underwent contrast-enhanced DECT before treatment between June 2019 and December 2021. The clinical, conventional CT qualitative, conventional CT quantitative, and DECT quantitative parameters of the two groups were compared using univariate analysis and selected by least absolute shrinkage and selection operator regression (LASSO) analysis. Multivariate logistic regression analyses were performed to build qualitative, conventional CT quantitative, DECT quantitative, and comprehensive models. The areas under the receiver operating characteristic curve (AUCs) of the models were compared using DeLong's test. RESULTS The AUCs of the DECT quantitative (based on normalized iodine concentrations [nICs] in the arterial and portal venous phases: 0.918; 95% confidence interval [CI] 0.852-0.985) and comprehensive (based on tumour location and nICs in the arterial and portal venous phases: 0.966; 95% CI 0.889-0.995) models were higher than those of the qualitative (based on tumour location: 0.782; 95% CI 0.665-0.899) and conventional CT quantitative (based on normalized conventional CT attenuation in the arterial phase: 0.665; 95% CI 0.533-0.797; all P < 0.05) models. The DECT quantitative and comprehensive models had comparable performances (P = 0.076). CONCLUSIONS Higher nICs in the arterial and portal venous phases were associated with higher blood supply improving the identification of non-hypervascular PNENs.
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Affiliation(s)
- Xuefang Hu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518000, Guangdong, China
| | - Siya Shi
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Yangdi Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Jiaxin Yuan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Mingjie Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Luyong Wei
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Weiwei Deng
- Clinical and Technical Support, Philips Healthcare China, Shanghai, 200072, China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Zhenpeng Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China.
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China.
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Hong Y, Zhong L, Lv X, Liu Q, Fu L, Zhou D, Yu N. Application of spectral CT in diagnosis, classification and prognostic monitoring of gastrointestinal cancers: progress, limitations and prospects. Front Mol Biosci 2023; 10:1284549. [PMID: 37954980 PMCID: PMC10634296 DOI: 10.3389/fmolb.2023.1284549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023] Open
Abstract
Gastrointestinal (GI) cancer is the leading cause of cancer-related deaths worldwide. Computed tomography (CT) is an important auxiliary tool for the diagnosis, evaluation, and prognosis prediction of gastrointestinal tumors. Spectral CT is another major CT revolution after spiral CT and multidetector CT. Compared to traditional CT which only provides single-parameter anatomical diagnostic mode imaging, spectral CT can achieve multi-parameter imaging and provide a wealth of image information to optimize disease diagnosis. In recent years, with the rapid development and application of spectral CT, more and more studies on the application of spectral CT in the characterization of GI tumors have been published. For this review, we obtained a substantial volume of literature, focusing on spectral CT imaging of gastrointestinal cancers, including esophageal, stomach, colorectal, liver, and pancreatic cancers. We found that spectral CT can not only accurately stage gastrointestinal tumors before operation but also distinguish benign and malignant GI tumors with improved image quality, and effectively evaluate the therapeutic response and prognosis of the lesions. In addition, this paper also discusses the limitations and prospects of using spectral CT in GI cancer diagnosis and treatment.
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Affiliation(s)
- Yuqin Hong
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Lijuan Zhong
- Department of Radiology, The People’s Hospital of Leshan, Leshan, China
| | - Xue Lv
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Qiao Liu
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Langzhou Fu
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Daiquan Zhou
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Na Yu
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
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Bernatz S, Koch V, Dos Santos DP, Ackermann J, Grünewald LD, Weitkamp I, Yel I, Martin SS, Lenga L, Scholtz JE, Vogl TJ, Mahmoudi S. Comparison of radiomics models and dual-energy material decomposition to decipher abdominal lymphoma in contrast-enhanced CT. Int J Comput Assist Radiol Surg 2023; 18:1829-1839. [PMID: 36877288 PMCID: PMC10497439 DOI: 10.1007/s11548-023-02854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/10/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE The radiologists' workload is increasing, and computational imaging techniques may have the potential to identify visually unequivocal lesions, so that the radiologist can focus on equivocal and critical cases. The purpose of this study was to assess radiomics versus dual-energy CT (DECT) material decomposition to objectively distinguish visually unequivocal abdominal lymphoma and benign lymph nodes. METHODS Retrospectively, 72 patients [m, 47; age, 63.5 (27-87) years] with nodal lymphoma (n = 27) or benign abdominal lymph nodes (n = 45) who had contrast-enhanced abdominal DECT between 06/2015 and 07/2019 were included. Three lymph nodes per patient were manually segmented to extract radiomics features and DECT material decomposition values. We used intra-class correlation analysis, Pearson correlation and LASSO to stratify a robust and non-redundant feature subset. Independent train and test data were applied on a pool of four machine learning models. Performance and permutation-based feature importance was assessed to increase the interpretability and allow for comparison of the models. Top performing models were compared by the DeLong test. RESULTS About 38% (19/50) and 36% (8/22) of the train and test set patients had abdominal lymphoma. Clearer entity clusters were seen in t-SNE plots using a combination of DECT and radiomics features compared to DECT features only. Top model performances of AUC = 0.763 (CI = 0.435-0.923) were achieved for the DECT cohort and AUC = 1.000 (CI = 1.000-1.000) for the radiomics feature cohort to stratify visually unequivocal lymphomatous lymph nodes. The performance of the radiomics model was significantly (p = 0.011, DeLong) superior to the DECT model. CONCLUSIONS Radiomics may have the potential to objectively stratify visually unequivocal nodal lymphoma versus benign lymph nodes. Radiomics seems superior to spectral DECT material decomposition in this use case. Therefore, artificial intelligence methodologies may not be restricted to centers with DECT equipment.
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Affiliation(s)
- Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- Dr. Senckenberg Institute for Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Daniel Pinto Dos Santos
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jörg Ackermann
- Department of Molecular Bioinformatics, Institute of Computer Science, Johann Wolfgang Goethe-University, Robert-Mayer-Str. 11-15, 60325 Frankfurt am Main, Germany
| | - Leon D. Grünewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Inga Weitkamp
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Simon S. Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Lukas Lenga
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Thomas J. Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Bucolo GM, D'Angelo T, Yel I, Koch V, Gruenewald LD, Othman AE, Alizadeh LS, Overhoff DP, Waldeck S, Martin SS, Mazziotti S, Ascenti G, Blandino A, Vogl TJ, Booz C. Virtual Monoenergetic Imaging of Lower Extremities Using Dual-Energy CT Angiography in Patients with Diabetes Mellitus. Diagnostics (Basel) 2023; 13:diagnostics13101790. [PMID: 37238274 DOI: 10.3390/diagnostics13101790] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) is the most common metabolic disorder in the world and an important risk factor for peripheral arterial disease (PAD). CT angiography represents the method of choice for the diagnosis, pre-operative planning, and follow-up of vascular disease. Low-energy dual-energy CT (DECT) virtual mono-energetic imaging (VMI) has been shown to improve image contrast, iodine signal, and may also lead to a reduction in contrast medium dose. In recent years, VMI has been improved with the use of a new algorithm called VMI+, able to obtain the best image contrast with the least possible image noise in low-keV reconstructions. PURPOSE To evaluate the impact of VMI+ DECT reconstructions on quantitative and qualitative image quality in the evaluation of the lower extremity runoff. MATERIALS AND METHODS We evaluated DECT angiography of lower extremities in patients suffering from diabetes who had undergone clinically indicated DECT examinations between January 2018 and January 2023. Images were reconstructed with standard linear blending (F_0.5) and low VMI+ series were generated from 40 to 100 keV, in an interval of 15 keV. Vascular attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated for objective analysis. Subjective analysis was performed using five-point scales to evaluate image quality, image noise, and diagnostic assessability of vessel contrast. RESULTS Our final study cohort consisted of 77 patients (41 males). Attenuation values, CNR, and SNR were higher in 40-keV VMI+ reconstructions compared to the remaining VMI+ and standard F_0.5 series (HU: 1180.41 ± 45.09; SNR: 29.91 ± 0.99; CNR: 28.60 ± 1.03 vs. HU 251.32 ± 7.13; SNR: 13.22 ± 0.44; CNR: 10.57 ± 0.39 in standard F_0.5 series) (p < 0.0001). Subjective image rating was significantly higher in 55-keV VMI+ images compared to the other VMI+ and standard F_0.5 series in terms of image quality (mean score: 4.77), image noise (mean score: 4.39), and assessability of vessel contrast (mean value: 4.57) (p < 0.001). CONCLUSIONS DECT 40-keV and 55-keV VMI+ showed the highest objective and subjective parameters of image quality, respectively. These specific energy levels for VMI+ reconstructions could be recommended in clinical practice, providing high-quality images with greater diagnostic suitability for the evaluation of lower extremity runoff, and potentially needing a lower amount of contrast medium, which is particularly advantageous for diabetic patients.
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Affiliation(s)
- Giuseppe Mauro Bucolo
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Hospital Mainz, 55131 Mainz, Germany
| | - Leona Soraja Alizadeh
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
| | - Daniel P Overhoff
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Stephan Waldeck
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, 56072 Koblenz, Germany
- Institute of Neuroradiology, University Medical Centre, Johannes Gutenberg University Mainz, 55099 Mainz, Germany
| | - Simon S Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
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Skornitzke S, Mayer P, Kauczor HU, Stiller W. Evaluation of optimal acquisition delays of DECT iodine maps in pancreatic adenocarcinoma: A potential alternative to the Patlak model of CT perfusion. Heliyon 2023; 9:e14726. [PMID: 37064458 PMCID: PMC10102198 DOI: 10.1016/j.heliyon.2023.e14726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 02/24/2023] [Accepted: 03/15/2023] [Indexed: 04/18/2023] Open
Abstract
Introduction By using bolus tracking with an appropriate acquisition delay dual-energy computed tomography (DECT) iodine maps might serve as a replacement of CT perfusion maps at reduced radiation exposure. This study aimed to evaluate the optimal acquisition delays of DECT for the replacement of parameter maps calculated with the Patlak model in pancreatic adenocarcinoma by corresponding iodine maps. Materials and methods Dual-source dynamic DECT acquisitions at 80 kVp/Sn140 kVp of 14 patients with pancreatic carcinoma were used to calculate CT perfusion maps of blood volume and permeability with the Patlak model. DECT iodine maps were generated from individual DECT acquisitions, matching acquisition times relative to prior bolus-triggered three-phase CT acquisitions for investigating different acquisition delays. Correlation between perfusion parameters and iodine concentrations was determined for acquisition delays between -6 s and 33 s. Results Correlation between iodine concentrations and perfusion parameters ranged from -0.05 to 0.63 for blood volume and from -0.05 to 0.71 for permeability, depending on potential trigger delay. The correlation was significant for potential acquisition delays above 1.5 s for blood volume and above 9.0 s for permeability (both p < 0.05). Maximum correlation occurred at an acquisition delay of 15.0 s for blood volume (r = 0.63) and at 25.5 s for permeability (r = 0.71), with significantly lower iodine concentrations in carcinoma (15.0 s: 1.3 ± 0.5 mg/ml; 22.5 s: 1.4 ± 0.7 mg/ml) than in non-neoplastic pancreatic parenchyma (15.0 s: 2.3 ± 0.8 mg/ml; 22.5 s: 2.4 ± 0.6 mg/ml; p < 0.05). Discussion In the future, well-timed DECT iodine maps acquired with bolus tracking could provide an alternative to permeability and blood volume maps calculated with the Patlak model.
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Affiliation(s)
| | | | | | - Wolfram Stiller
- Corresponding author. Diagnostic and Interventional Radiology (DIR) Heidelberg University Hospital Im Neuenheimer Feld 130.3 69120 Heidelberg, Germany
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Sartoretti T, Mergen V, Jungblut L, Alkadhi H, Euler A. Liver Iodine Quantification With Photon-Counting Detector CT: Accuracy in an Abdominal Phantom and Feasibility in Patients. Acad Radiol 2023; 30:461-469. [PMID: 35644755 DOI: 10.1016/j.acra.2022.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVES To compare the accuracy of iodine quantification in liver parenchyma and lesions between dual-source photon-counting detector CT (PCD-CT) and dual-source energy-integrating detector CT (EID-CT) in a phantom and to demonstrate the feasibility of iodine quantification with PCD-CT in liver parenchyma and lesions in patients. MATERIALS AND METHODS An anthropomorphic abdominal phantom with a liver insert containing parenchyma and lesions was imaged on a clinical PCD-CT at 120kV and in the dual-energy mode on an EID-CT with kV-combinations of 80/Sn150kV, 90/Sn150kV, and 100/Sn150kV. Three patient sizes were imaged at three different radiation doses (CTDIvol: 5, 10, 15mGy). Thirty patients with liver cysts, hemangiomas or metastases imaged with PCD-CT were retrospectively included. Iodine maps were reconstructed and iodine concentrations were measured in liver parenchyma and lesions. For the phantom, iodine error was quantified as the absolute difference to the vendor's specifications as reference. RESULTS Overall iodine error was 0.33 ± 0.29, 0.34 ± 0.32, 0.39 ± 0.37, 0.35 ± 0.39 mgI/mL for 80/Sn150kV, 90/Sn150kV, 100/Sn150kV of EID-CT, and PCD-CT, respectively, without significant differences between PCD-CT and EID-CT (p > 0.05). Radiation dose did not significantly influence error of PCD-CT (p > 0.05) nor EID-CT (p > 0.05). For both scanners, smaller patient sizes were associated with lower errors (p < 0.05). Iodine concentration and base material attenuation significantly influenced quantification for EID-CT (p < 0.05) but not PCD-CT (p > 0.05). In patients, iodine quantification was feasible in liver parenchyma, cysts, hemangiomas, and metastases. CONCLUSION Iodine quantification with PCD-CT is accurate in simulated liver parenchyma and lesions irrespective of radiation dose, iodine concentration, and base attenuation and is feasible in common liver lesions in patients.
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Affiliation(s)
- Thomas Sartoretti
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-809, Zurich, Switzerland
| | - Victor Mergen
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-809, Zurich, Switzerland
| | - Lisa Jungblut
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-809, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-809, Zurich, Switzerland
| | - André Euler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-809, Zurich, Switzerland.
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12
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D’Angelo T, Arico FM, Broccio L, Ascenti G, Mazziotti S, Booz C, Martin SS, Yel I, Lanzafame LRM, Blandino A, Sofia C. Multi-Contrast Differentiation by Dual-Energy Spectral CT Angiography in a Patient with Pulmonary Barium Granulomas. Diagnostics (Basel) 2023; 13:diagnostics13050832. [PMID: 36899976 PMCID: PMC10000742 DOI: 10.3390/diagnostics13050832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Barium inhalation usually relates to accidental aspiration during radiological procedures with an oral contrast agent. When present, barium lung deposits are visible as high-density opacities on chest X-ray or CT scan due to high atomic number, and they may be indistinguishable from calcifications. Dual-layer spectral CT has shown good material differentiation capabilities, due to its increased high-Z element range and smaller spectral separation between low- and high-energy spectral data. We present the case of a 17-year-old female with a history of tracheoesophageal fistula, who underwent chest CT angiography on a dual-layer spectral platform. Despite the close Z numbers and K-edge energy levels of the two different contrast materials, spectral CT was able to identify barium lung deposits from a previous swallowing study and to clearly distinguish them from calcium and the surrounding iodine-containing structures.
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Affiliation(s)
- Tommaso D’Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Correspondence: (T.D.); (F.M.A.)
| | - Francesco M. Arico
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
- Correspondence: (T.D.); (F.M.A.)
| | - Lydia Broccio
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
| | - Giorgio Ascenti
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
| | - Silvio Mazziotti
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Simon S. Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Ludovica R. M. Lanzafame
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
| | - Alfredo Blandino
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
| | - Carmelo Sofia
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, Italy
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Yu HS, Keraliya A, Chakravarti S, Uyeda JW. Multienergy Computed Tomography Applications. Radiol Clin North Am 2023; 61:23-35. [DOI: 10.1016/j.rcl.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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14
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Mahmoudi S, Bernatz S, Althoff FC, Koch V, Grünewald LD, Scholtz JE, Walter D, Zeuzem S, Wild PJ, Vogl TJ, Kinzler MN. Dual-energy CT based material decomposition to differentiate intrahepatic cholangiocarcinoma from hepatocellular carcinoma. Eur J Radiol 2022; 156:110556. [PMID: 36270195 DOI: 10.1016/j.ejrad.2022.110556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/29/2022] [Accepted: 10/07/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the potential of material decomposition in dual-energy CT (DECT) to differentiate intrahepatic cholangiocarcinoma (iCCA) from hepatocellular carcinoma (HCC). METHOD In this retrospective study, we included 94 patients (26 female (27.7 %), median age 64.5 (interquartile range 55.5-74.5) years) with either iCCA or HCC who underwent abdominal contrast-enhanced DECT in arterial phase. To test for differences between iCCA (n = 47) and HCC (n = 47), we evaluated mean attenuation and DECT material density values including iodine density (ID), normalized iodine uptake (NIU), fat fraction, and lesion-to-liver parenchyma ratio. Histopathology served as reference standard for all lesions. We used univariate logistic regression models for the outcome iCCA versus HCC. ROC curve analysis was applied to assess discriminative ability of the model. Model accuracy was evaluated by calculating the Brier score. Youden index was applied to establish thresholds to differentiate between iCCA and HCC. RESULTS Comparison of quantitative image parameters revealed significant differences between iCCA and HCC for ID (1.6 ± 0.5 mg/ml vs 2.8 ± 0.8 mg/ml, p < 0.001), NIU (14.5 ± 4.8 vs 24.8 ± 10.3, p < 0.001), attenuation (41.9 ± 10.1 HU vs 47.9 ± 8.9 HU, p = 0.003), and fat fraction (12.0 ± 7.8 % vs 9.0 ± 6.4 %, p = 0.045). ROC curve analysis revealed highest ability to differentiate iCCA from HCC for ID (AUC = 0.93, 95 % CI 0.89-0.98). For ID, an optimal threshold of 2.33 mg/dl was determined to discriminate between iCCA and HCC (sensitivity 89.4 %, specificity 76.6 %). CONCLUSIONS DECT-based iodine quantification can serve as a tool for the differentiation of iCCA and HCC in contrast-enhanced CT. ID yielded the highest diagnostic performance and may assist in clinical routine CT diagnostics.
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Affiliation(s)
- Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Friederike C Althoff
- Department of Internal Medicine II, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Leon D Grünewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Dirk Walter
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Stefan Zeuzem
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Peter J Wild
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany; Wildlab, University Hospital Frankfurt MVZ GmbH, Frankfurt am Main, Germany.
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Maximilian N Kinzler
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
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15
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Winkelmann MT, Hagen F, Artzner K, Bongers MN, Artzner C. Dual-Energy CT for Accurate Discrimination of Intraperitoneal Hematoma and Intestinal Structures. Diagnostics (Basel) 2022; 12:diagnostics12102542. [PMID: 36292231 PMCID: PMC9601488 DOI: 10.3390/diagnostics12102542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to evaluate the potential of dual-energy CT (DECT) with virtual unenhanced imaging (VNC) and iodine maps (IM) to differentiate between intraperitoneal hematomas (IH) and bowel structures (BS) compared to linearly blended DECT (DE-LB) images (equivalent to single-energy CT). This retrospective study included the DECT of 30 patients (mean age: 64.5 ± 15.1 years, 19 men) with intraperitoneal hematomas and 30 negative controls. VNC, IM, and DE-LB were calculated. Imaging follow-up and surgical reports were used as references. Three readers assessed diagnostic performance and confidence in distinguishing IH and BS for DE-LB, VNC, and IM. Diagnostic confidence was assessed on a five-point Likert scale. The mean values of VNC, IM, and DE-LB were compared with nonparametric tests. Diagnostic accuracy was assessed by calculating receiver operating characteristics (ROC). The results are reported as medians with interquartile ranges. Subjective image analysis showed higher diagnostic performance (sensitivity: 96.7−100% vs. 88.2−96.7%; specificity: 100% vs. 96.7−100%; p < 0.0001; ICC: 0.96−0.99) and confidence (Likert: 5; IRQ [5−5] vs. 4, IRQ [3−4; 4−5]; p < 0.0001; ICC: 0.80−0.96) for DECT compared to DE-LB. On objective image analysis, IM values for DECT showed significant differences between IH (3.9 HU; IQR [1.6, 8.0]) and BS (39.5 HU; IQR [29.2, 43.3]; p ≤ 0.0001). VNC analysis revealed a significantly higher attenuation of hematomas (50.5 HU; IQR [44.4, 59.4]) than BS (26.6 HU; IQR [22.8, 32.4]; p ≤ 0.0001). DE-LB revealed no significant differences between hematomas (60.5 HU, IQR [52.7, 63.9]) and BS (63.9 HU, IQR [58.0, 68.8]; p > 0.05). ROC analysis revealed the highest AUC values and sensitivity for IM (AUC = 100%; threshold by Youden-Index ≤ 19 HU) and VNC (0.93; ≥34.1 HU) compared to DE-LB (0.64; ≤63.8; p < 0.001). DECT is suitable for accurate discrimination between IH and BS by calculating iodine maps and VNC images.
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Affiliation(s)
- Moritz T. Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Florian Hagen
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Kerstin Artzner
- Department of Internal Medicine I, Comprehensive Cancer Center, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Malte N. Bongers
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Christoph Artzner
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
- Correspondence:
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New frontiers in imaging including radiomics updates for pancreatic neuroendocrine neoplasms. Abdom Radiol (NY) 2022; 47:3078-3100. [PMID: 33095312 DOI: 10.1007/s00261-020-02833-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To illustrate the applications of various imaging tools including conventional MDCT, MRI including DWI, CT & MRI radiomics, FDG & DOTATATE PET-CT for diagnosis, staging, grading, prognostication, treatment planning and assessing treatment response in cases of pancreatic neuroendocrine neoplasms (PNENs). BACKGROUND Gastroenteropancreatic neuroendocrine neoplasms (GEP NENs) are very diverse clinically & biologically. Their treatment and prognosis depend on staging and primary site, as well as histological grading, the importance of which is also reflected in the recently updated WHO classification of GEP NENs. Grade 3 poorly differentiated neuroendocrine carcinomas (NECs) are aggressive & nearly always advanced at diagnosis with poor prognosis; whereas Grades-1 and 2 well-differentiated neuroendocrine tumors (NETs) can be quite indolent. Grade 3 well-differentiated NETs represent a new category of neoplasm with an intermediate prognosis. Importantly, the evidence suggest grade heterogeneity can occur within a given tumor and even grade progression can occur over time. Emerging evidence suggests that several non-invasive qualitative and quantitative imaging features on CT, dual-energy CT (DECT), MRI, PET and somatostatin receptor imaging with new tracers, as well as texture analysis, may be useful to grade, prognosticate, and accurately stage primary NENs. Imaging features may also help to inform choice of treatment and follow these neoplasms post-treatment. CONCLUSION GEP NENs treatment and prognosis depend on the stage as well as histological grade of the tumor. Traditional ways of imaging evaluation for diagnosis and staging does not yet yield sufficient information to replace operative and histological evaluation. Recognition of important qualitative imaging features together with quantitative features and advanced imaging tools including functional imaging with DWI MRI, DOTATATE PET/CT, texture analysis with radiomics and radiogenomic features appear promising for more accurate staging, tumor risk stratification, guiding management and assessing treatment response.
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Toshav A. Economics of Dual-Energy CT: Workflow, Costs, and Benefits. Semin Ultrasound CT MR 2022; 43:352-354. [PMID: 35738820 DOI: 10.1053/j.sult.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dual-energy CT is an emerging technology which is progressively becoming more available for routine clinical applications. As practices and institutions evaluate the business case for purchase of these high-end scanners, the clinical utility and downstream costs must be determined. This article will provide an overview of the technology and will review direct and indirect costs associated with the implementation of dual-energy CT programs.
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Affiliation(s)
- Aran Toshav
- Department of Radiology, Southeast Louisiana Veterans Healthcare System, LSUHSC New Orleans, Louisiana USA.
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18
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Ren T, Zhang W, Li S, Deng L, Xue C, Li Z, Liu S, Sun J, Zhou J. Combination of clinical and spectral-CT parameters for predicting lymphovascular and perineural invasion in gastric cancer. Diagn Interv Imaging 2022; 103:584-593. [DOI: 10.1016/j.diii.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 11/03/2022]
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Ramachandran A, Madhusudhan KS. Advances in the imaging of gastroenteropancreatic neuroendocrine neoplasms. World J Gastroenterol 2022; 28:3008-3026. [PMID: 36051339 PMCID: PMC9331531 DOI: 10.3748/wjg.v28.i26.3008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/30/2021] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
Gastroenteropancreatic neuroendocrine neoplasms comprise a heterogeneous group of tumors that differ in their pathogenesis, hormonal syndromes produced, biological behavior and consequently, in their requirement for and/or response to specific chemotherapeutic agents and molecular targeted therapies. Various imaging techniques are available for functional and morphological evaluation of these neoplasms and the selection of investigations performed in each patient should be customized to the clinical question. Also, with the increased availability of cross sectional imaging, these neoplasms are increasingly being detected incidentally in routine radiology practice. This article is a review of the various imaging modalities currently used in the evaluation of neuroendocrine neoplasms, along with a discussion of the role of advanced imaging techniques and a glimpse into the newer imaging horizons, mostly in the research stage.
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Affiliation(s)
- Anupama Ramachandran
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
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Radiomic Analysis of Pulmonary Nodules for Distinguishing Malignancy From Benignancy: The Value of Using Iodine Maps From Dual-Energy Computed Tomography. J Comput Assist Tomogr 2022; 46:878-883. [PMID: 35830384 DOI: 10.1097/rct.0000000000001360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study is to investigate the diagnostic accuracy of radiomics on iodine maps from dual-energy computed tomography (DECT) in distinguishing lung cancer from benign pulmonary nodules. METHODS This retrospective study was approved by the institutional review board, and written informed consent was waived. A total of 109 patients with 55 malignant nodules and 62 benign nodules underwent contrast-enhanced DECT. Eight iodine uptake parameters on iodine maps generated by DECT were calculated and established a predictive model. Eighty-seven radiomics features of entire tumor were extracted from iodine maps and established a radiomics model. The iodine uptake model and radiomics model were independently built based on the highly reproducible features using the least absolute shrinkage and selection operator method. The diagnostic accuracy of 2 models were assessed using receiver operating curve analysis. For external validation, 47 patients (25 benign and 22 malignant) from another hospital were assigned to testing data set. RESULTS All iodine uptake features showed significant association with malignancy (P < 0.01) and 2 selected features (mean value of virtual noncontrast images and mean value of vital part on contrast-enhanced image) constituted the iodine model. The radiomics model comprised 2 features (original shape sphericity and original glszm small area high gray level emphasis), which showed good discrimination both in the training cohort (area under the curve, 0.957) and validation cohort (area under the curve, 0.800). Radiomics model showed superior performance than iodine uptake model (accuracy, 89.7% vs 80.6%). CONCLUSIONS Radiomics model extracted from iodine maps provided a robust diagnostic tool for discriminating pulmonary malignant nodules and had high potential in clinical application.
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Koch V, Albrecht MH, Gruenewald LD, Yel I, Eichler K, Gruber-Rouh T, Hammerstingl RM, Burck I, Wichmann JL, Alizadeh LS, Vogl TJ, Lenga L, Wesarg S, Martin SS, Mader C, Dimitrova M, D'Angelo T, Booz C. Impact of Intravenously Injected Contrast Agent on Bone Mineral Density Measurement in Dual-Source Dual-Energy CT. Acad Radiol 2022; 29:880-887. [PMID: 34266738 DOI: 10.1016/j.acra.2021.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess the influence of intravenously injected contrast agent on bone mineral density (BMD) assessment in dual-source dual-energy CT. METHODS This retrospective study included 1,031 patients (mean age, 53 ± 7 years; 519 women) who had undergone third-generation dual-source dual-energy CT in context of tumor staging between January 2019 and December 2019. Dedicated postprocessing software based on material decomposition was used for phantomless volumetric BMD assessment of trabecular bone of the lumbar spine. Volumetric trabecular BMD values derived from unenhanced and contrast-enhanced portal venous phase were compared by calculating correlation and agreement analyses using Pearson product-moment correlation, linear regression, and Bland-Altman plots. RESULTS Mean BMD values were 115.53 ± 37.23 and 116.10 ± 37.78 mg/cm3 in unenhanced and contrast-enhanced dual-energy CT series, respectively. Values from contrast-enhanced portal venous phase differed not significantly from those of the unenhanced phase (p = 0.44) and showed high correlation (r = 0.971 [95% CI, 0.969-0.973]) with excellent agreement in Bland-Altman plots. Mean difference of the two phases was 0.61 mg/cm3 (95% limits of agreement, -17.14 and 18.36 mg/cm3). CONCLUSION Portal venous phase dual-source dual-energy CT allows for accurate opportunistic BMD assessment of trabecular bone of the lumbar spine compared to unenhanced imaging. Therefore, dual-source CT may provide greater flexibility regarding BMD assessment in clinical routine and reduce radiation exposure by avoiding additional osteodensitometry examinations, as contrast-enhanced CT scans in context of tumor staging are increasingly performed in dual-energy mode.
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Affiliation(s)
- Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Moritz H Albrecht
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Renate M Hammerstingl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Iris Burck
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Julian L Wichmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Leona S Alizadeh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lukas Lenga
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan Wesarg
- Fraunhofer IGD, Cognitive Computing & Medical Imaging, Darmstadt, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christoph Mader
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Mirela Dimitrova
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany.
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Canakis A, Lee LS. Current updates and future directions in diagnosis and management of gastroenteropancreatic neuroendocrine neoplasms. World J Gastrointest Endosc 2022; 14:267-290. [PMID: 35719897 PMCID: PMC9157694 DOI: 10.4253/wjge.v14.i5.267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/14/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Gastroenteropancreatic neuroendocrine neoplasms are a heterogenous group of rare neoplasms that are increasingly being discovered, often incidentally, throughout the gastrointestinal tract with varying degrees of activity and malignant potential. Confusing nomenclature has added to the complexity of managing these lesions. The term carcinoid tumor and embryonic classification have been replaced with gastroenteropancreatic neuroendocrine neoplasm, which includes gastrointestinal neuroendocrine and pancreatic neuroendocrine neoplasms. A comprehensive multidisciplinary approach is important for clinicians to diagnose, stage and manage these lesions. While histological diagnosis is the gold standard, recent advancements in endoscopy, conventional imaging, functional imaging, and serum biomarkers complement histology for tailoring specific treatment options. In light of developing technology, our review sets out to characterize diagnostic and therapeutic advancements for managing gastroenteropancreatic neuroendocrine tumors, including innovations in radiolabeled peptide imaging, circulating biomarkers, and endoscopic treatment approaches adapted to different locations throughout the gastrointestinal system.
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Affiliation(s)
- Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD 21201, United States
| | - Linda S Lee
- Division of Gastroenterology Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
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Dual-energy CT of acute bowel ischemia. Abdom Radiol (NY) 2022; 47:1660-1683. [PMID: 34191075 DOI: 10.1007/s00261-021-03188-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/17/2022]
Abstract
Acute bowel ischemia is a condition with high mortality and requires rapid intervention to avoid catastrophic outcomes. Swift and accurate imaging diagnosis is essential because clinical findings are commonly nonspecific. Conventional contrast enhanced CT of the abdomen has been the imaging modality of choice to evaluate suspected acute bowel ischemia. However, subtlety of image findings and lack of non-contrast or arterial phase images can make correct diagnosis challenging. Dual-energy CT provides valuable information toward assessing bowel ischemia. Dual-energy CT exploits the differential X-ray attenuation at two different photon energy levels to characterize the composition of tissues and reveal the presence or absence of faint intravenous iodinated contrast to improve reader confidence in detecting subtle bowel wall enhancement. With the same underlying technique, virtual non-contrast images can help to show non-enhancing hyperdense hemorrhage of the bowel wall in intravenous contrast-enhanced scans without the need to acquire actual non-contrast scans. Dual-energy CT derived low photon energy (keV) virtual monoenergetic images emphasize iodine contrast and provide CT angiography-like images from portal venous phase scans to better evaluate abdominal arterial patency. In Summary, dual-energy CT aids diagnosing acute bowel ischemia in multiple ways, including improving visualization of the bowel wall and mesenteric vasculature, revealing intramural hemorrhage in contrast enhanced scans, or possibly reducing intravenous contrast dose.
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Utility of Quantitative Metrics from Dual-Layer Spectral-Detector CT for Differentiation of Pancreatic Neuroendocrine Tumor and Neuroendocrine Carcinoma. AJR Am J Roentgenol 2022; 218:999-1009. [PMID: 35043668 DOI: 10.2214/ajr.21.27017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: The 2019 WHO classification separates neuroendocrine neoplasms (NENs) into neuroendocrine tumors (NET) and neuroendocrine carcinomas (NEC), which are considered to represent pathologically distinct entities warranting different management approaches. Dual-layer spectral-detector CT (DLCT) may aid their differentiation through specific material decomposition. Objective: To assess the utility of quantitative metrics derived from DLCT for the differentiation of pancreatic NET and NEC. Methods: This retrospective study included 104 patients (mean age 51±13 years; 53 women, 51 men) with pathologically confirmed NEN [89 NET, including 22 grade 1, 48 grade 2, and 19 grade 3 (G3); 15 NEC], who underwent multiphase DLCT within 15 days before biopsy or resection. Two radiologists independently placed ROIs to record tumor attenuation, iodine concentration (IC), and effective atomic number (Zeff) across phases, and also assessed qualitative features (composition, homogeneity, margins, calcifications, main pancreatic duct dilation, vascular invasion, lymphadenopathy). Interreader agreement was assessed. Mean values between readers were obtained for quantitative measures; consensus was reached for qualitative features. NET and NEC were compared using multivariable regression analysis and ROC analysis. Results: Interobserver agreement, expressed as intraclass correlation coefficients, ranged from 0.879 to 0.992 for quantitative metrics, and, expressed as kappa coefficients, from 0.763 to 0.823 for qualitative features. In multivariable analysis of qualitative and quantitative features, significant independent predictors of NEC (P<.05) were IC in portal venous phase (1.3 mg/mL in NEC vs 2.7 mg/mL in NET), Zeff in portal venous phase (8.1 vs 8.6), and attenuation in portal venous phase (78.2 vs 113.5 HU). AUC for predicting NEC was 0.897 for IC, 0.884 for Zeff, 0.921 for combination of IC and Zeff, and 0.855 for attenuation. Predicted probability based on combination of IC and Zeff achieved sensitivity of 93.3% and specificity of 80.9% for NEC. Significant independent predictors (P<.05) for differentiating G3 NET and NEC were IC (1.3 vs 2.0 mg/mL; AUC=0.789) and attenuation (78.2 vs 90.3 HU; AUC=0.647), both measured in portal venous phase. Conclusion: Incorporation of DLCT-metrics improves differentiation of NET and NEC compared with conventional CT attenuation and qualitative features. Clinical Impact: DLCT may help select patients with pancreatic NENs for platinum-based chemotherapies.
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Dual-Energy Computed Tomography Imaging in Early-Stage Hepatocellular Carcinoma: A Preliminary Study. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:2146343. [PMID: 35069041 PMCID: PMC8752295 DOI: 10.1155/2022/2146343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022]
Abstract
Background This study aims to evaluate the application of dual-energy computed tomography (DECT) for multiparameter quantitative measurement in early-stage hepatocellular carcinoma (HCC). Methods The study retrospectively enrolled 30 patients with early-stage HCC and 43 patients with early-stage HCC who received radiofrequency ablation (RFA) and underwent abdomen enhanced CT scans in GSI mode. The GSI viewer was used for image display and data analysis. The regions of interest (ROIs) were delineated in the arterial phase and the venous phase. The optimal single energy value, CT values on different energy levels (40 keV, 70 keV, 100 keV, and 140 keV), the optimal energy level, the slope of the spectral attenuation curve, the effective atomic number (Zeff), iodine concentration (IC), water concentration (WC), normalized iodine concentration (NIC), and normalized water concentration (NWC) are measured and quantitatively analyzed. Results The CT values of early-stage HCC at different single energy levels in dual phases were significantly different, and the single energy values were negatively correlated with the CT values. In the arterial phase and the venous phase, the optimal energy values for the best contrast-to-noise ratio were (68.34 ± 3.20) keV and (70.14 ± 2.01) keV, respectively. The slope of the spectral attenuation curve showed a downward trend at 40 keV, 70 keV, 100 keV, and 140 keV, but there was no statistically significant difference (P > 0.05). Zeff was positively correlated with IC and standardized IC, but has no significant correlation with WC and NWC in dual phases. Conclusion DECT imaging contains multiparameter information and has different application values for early-stage HCC, and it is necessary to select the parameters reasonably for personalized and comprehensive evaluation.
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Voss BA, Khandelwal A, Wells ML, Inoue A, Venkatesh SK, Lee YS, Johnson MP, Fletcher JG. Impact of dual-energy 50-keV virtual monoenergetic images on radiologist confidence in detection of key imaging findings of small hepatocellular carcinomas using multiphase liver CT. Acta Radiol 2021; 63:1443-1452. [PMID: 34723681 DOI: 10.1177/02841851211052993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dual-energy virtual monoenergetic images can increase iodine signal, potentially increasing the conspicuity of hepatic masses. PURPOSE To determine if dual-energy 50-keV virtual monoenergetic images improve visualization of key imaging findings or diagnostic confidence for small (≤2 cm) hepatocellular carcinomas (HCC) at multiphase, contrast-enhanced liver computed tomography (CT). MATERIAL AND METHODS Patients with chronic liver disease underwent multiphase dual-energy CT imaging for HCC, with late arterial and delayed phase dual-energy 50-keV images reconstructed. Two non-reader subspecialized gastrointestinal (GI) radiologists established the reference standard, determining the location and diagnosis of all hepatic lesions using predetermined criteria. Three GI radiologists interpreted mixed kV CT images without or with dual-energy 50-keV images. Radiologists identified potential HCCs and rated their confidence (0-100 scales) in imaging findings of arterial enhancement, enhancing capsule, tumor washout, and LI-RADS 5 (2018) category. RESULTS In total, 45 patients (14 women; mean age = 59.5 ± 10.9 years) with chronic liver disease were included. Of them, 19 patients had 25 HCCs ≤2 cm (mean size = 1.5 ± 0.4 cm). There were 17 LI-RADS 3 and 4 lesions and 19 benign lesions. Reader confidence in imaging findings of arterial enhancement, enhancing capsule, and non-peripheral washout significantly increased with dual-energy images (P ≤ 0.022). Overall confidence in HCC diagnosis increased significantly with dual-energy 50-keV images (52.4 vs. 68.8; P = 0.001). Dual-energy images demonstrated a slight but significant decrease in overall image quality. CONCLUSION Radiologist confidence in key imaging features of small HCCs and confidence in imaging diagnosis increases with use of dual-energy 50-keV images at multiphase, contrast-enhanced liver CT.
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Affiliation(s)
| | | | | | - Akitoshi Inoue
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Yong S Lee
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Matthew P Johnson
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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Green CA, Solomon JB, Ruchala KJ, Samei E. Design and implementation of a practical quality control program for dual-energy CT. J Appl Clin Med Phys 2021; 22:249-260. [PMID: 34472700 PMCID: PMC8504583 DOI: 10.1002/acm2.13396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 12/16/2022] Open
Abstract
A novel routine dual‐energy computed tomography (DECT) quality control (QC) program was developed to address the current deficiency of routine QC for this technology. The dual‐energy quality control (DEQC) program features (1) a practical phantom with clinically relevant materials and concentrations, (2) a clinically relevant acquisition, reconstruction, and postprocessing protocol, and (3) a fully automated analysis software to extract quantitative data for database storage and trend analysis. The phantom, designed for easy set up for standalone or adjacent imaging next to the ACR phantom, was made in collaboration with an industry partner and informed by clinical needs to have four iodine inserts (0.5, 1, 2, and 5 mg/ml) and one calcium insert (100 mg/ml) equally spaced in a cylindrical water‐equivalent background. The imaging protocol was based on a clinical DECT abdominal protocol capable of producing material specific concentration maps, virtual unenhanced images, and virtual monochromatic images. The QC automated analysis software uses open‐source technologies which integrates well with our current automated CT QC database. The QC program was tested on a GE 750 HD scanner and two Siemens SOMATOM FLASH scanners over a 3‐month period. The automated algorithm correctly identified the appropriate region of interest (ROI) locations and stores measured values in a database for monitoring and trend analysis. Slight variations in protocol settings were noted based on manufacturer. Overall, the project proved to provide a convenient and dependable clinical tool for routine oversight of DE CT imaging within the clinic.
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Affiliation(s)
- Crystal A Green
- Department of Radiology, Clinical Imaging Physics Group, Duke University Medical Center, Durham, North Carolina, USA
| | - Justin B Solomon
- Clinical Imaging Physics Group, Carl E. Ravin Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Ehsan Samei
- Department of Radiology, Clinical Imaging Physics Group, Carl E. Ravin Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina, USA
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Spectral CT Hybrid Images in the Diagnostic Evaluation of Hypervascular Abdominal Tumors-Potential Advantages in Clinical Routine. Diagnostics (Basel) 2021; 11:diagnostics11091539. [PMID: 34573880 PMCID: PMC8471266 DOI: 10.3390/diagnostics11091539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background: This study aimed to investigate the use of spectral computed tomography (SCT) hybrid images combining virtual monoenergetic images (VMIs) and iodine maps (IMs) as a potentially efficient search series for routine clinical imaging in patients with hypervascular abdominal tumors. Methods: A total of 69 patients with hypervascular abdominal tumors including neuroendocrine neoplasms (NENs, n = 48), renal cell carcinoma (RCC, n = 10), and primary hepatocellular carcinoma (HCC, n = 11) were analyzed retrospectively. Two radiological readers (blinded to clinical data) read three CT image sets (1st a reference set with 70 keV; 2nd a 50:50 hybrid 140 keV/40 keV set; 3rd a 50:50 hybrid 140 keV/IM set). They assessed images subjectively by rating several parameters including image contrast, visibility of suspicious lesions, and diagnostic confidence on five-point Likert scales. In addition, reading time was estimated. Results: Median subjective Likert scores were highest for the 1st set, except for image contrast, for which the 2nd set was rated highest. Scores for diagnostic confidence, artifacts, noise, and visibility of suspicious lesions or small structures were significantly higher for the 1st set than for the 2nd or 3rd set (p < 0.001). Regarding image contrast, the 2nd set was rated significantly higher than the 3rd set (p < 0.001), while the median did not differ significantly compared with the 1st set. Agreement between the two readers was high for all sets. Estimated potential reading time was the same for hybrid and reference sets. Conclusions: Hybrid images have the potential to efficiently exploit the additional information provided by SCT in patients with hypervascular abdominal tumors. However, the use of rigid weighting did not significantly improve diagnostic performance in this study.
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Gassenmaier S, Kähm K, Walter SS, Machann J, Nikolaou K, Bongers MN. Quantification of liver and muscular fat using contrast-enhanced Dual Source Dual Energy Computed Tomography compared to an established multi-echo Dixon MRI sequence. Eur J Radiol 2021; 142:109845. [PMID: 34271430 DOI: 10.1016/j.ejrad.2021.109845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/17/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the feasibility of liver fat quantification in contrast-enhanced dual source dual energy computed tomography (DECT) using multi-echo Dixon magnetic resonance imaging (MRI) as reference standard. METHOD Patients who underwent MRI of the liver including a multi-echo Dixon sequence for estimation of proton density fat fraction in 2017 as well as contrast-enhanced DECT imaging of the abdomen were included in this retrospective, monocentric IRB approved study. Furthermore, patients with a hepatic fat amount >5% who were examined in 2018 with MRI and DECT were included. The final study group consisted of 81 patients with 90 pairs of examinations. Analysis of parameter maps was performed manually using congruent regions of interest which were placed in the liver parenchyma, in the erector spinae muscles, and psoas major muscles. RESULTS Mean patient age was 61 ± 13 years. Median time between MRI and DECT was 48 days. MRI liver fat quantification resulted in a median of 3.8% (IQR: 2.2-8.2%) compared to 1.8% (IQR: 0-6.3%) in DECT (p < 0.001), with a Spearman correlation of 0.73. Bland-Altman analysis resulted in a systematic underestimation of liver fat in DECT, with a mean difference of -1.7%. Fat quantification in the erector spinae muscles (p = 0.257) and the psoas major muscles (p = 0.208) was not significantly different in DECT compared to MRI. CONCLUSIONS Liver and muscular fat quantification in portal-venous phase DECT is feasible with good to excellent correlation compared to a multi-echo Dixon MRI sequence analysis. While there is an underestimation of the liver fat content in DECT, there are no significant differences between DECT and MRI fat quantification of the erector spinae and psoas major muscles.
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Affiliation(s)
- Sebastian Gassenmaier
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Karin Kähm
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Sven S Walter
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Jürgen Machann
- Section of Experimental Radiology, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Malte N Bongers
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
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Lenga L, Lange M, Arendt CT, Yel I, Booz C, Durden J, Leithner D, Vogl TJ, Albrecht MH, Martin SS. Can Dual-energy CT-based Virtual Monoenergetic Imaging Improve the Assessment of Hypodense Liver Metastases in Patients With Hepatic Steatosis? Acad Radiol 2021; 28:769-777. [PMID: 32446765 DOI: 10.1016/j.acra.2020.03.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the impact of noise-optimized virtual monoenergetic imaging (VMI) on lesion demarcation and measuring accuracy of hypoattenuating liver metastases in patients with fatty liver disease compared to standard reconstructions. MATERIALS AND METHODS Twenty-eight patients (mean age 62.2 ± 7.7 years) with fatty liver disease and hypoattenuating liver metastases who underwent unenhanced and contrast-enhanced portal-venous dual-energy CT (DECT) were enrolled. Standard linearly blended and VMI series were reconstructed in 10-keV intervals. Lesion-to-parenchyma contrast-to-noise ratio (CNR) was calculated and the best VMI series was further investigated in a subjective evaluation of overall image quality and lesion demarcation. Size measurements were performed independently by measuring all hypodense lesions (n = 58) twice in a predefined sequence. Inter- and intra-rater agreement was assessed using intra-class correlation coefficient (ICC) statistics. RESULTS The calculated CNR was greatest at 40-keV VMI (4.3 ± 2.6), significantly higher compared to standard reconstructions (2.9 ± 1.9; p < 0.001). Subjective ratings for overall image quality showed no significant difference between the 2 reconstruction techniques (both medians 4; p = 0.147), while lesion margin demarcation was found to be superior for 40-keV VMI (median 5; p ≤ 0.001). Inter- (ICC, 0.98 for 40-keV VMI; ICC, 0.93 for standard reconstruction) and intra-rater (ICC, 0.99 for 40-keV VMI; ICC, 0.94 for standard image series) analysis showed an excellent agreement for lesion measurements in both reconstruction techniques. CONCLUSION Noise-optimized VMI reconstructions significantly improve contrast and lesion demarcation of hypoattenuating liver metastases in patients with the fatty liver disease compared to standard reconstruction.
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Affiliation(s)
- Lukas Lenga
- University Hospital Frankfurt, Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Marvin Lange
- University Hospital Frankfurt, Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Christophe T Arendt
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Ibrahim Yel
- University Hospital Frankfurt, Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Christian Booz
- University Hospital Frankfurt, Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - James Durden
- Medical University of South Carolina, Department of Radiology and Radiological Science, 25 Courtenary Drive, 29401 Charleston, South Carolina
| | - Doris Leithner
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Thomas J Vogl
- University Hospital Frankfurt, Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Moritz H Albrecht
- University Hospital Frankfurt, Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
| | - Simon S Martin
- University Hospital Frankfurt, Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
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Laroia ST, Yadav K, Kumar S, Rastogi A, Kumar G, Sarin SK. Material decomposition using iodine quantification on spectral CT for characterising nodules in the cirrhotic liver: a retrospective study. Eur Radiol Exp 2021; 5:22. [PMID: 34046753 PMCID: PMC8160046 DOI: 10.1186/s41747-021-00220-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 04/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background There is limited scientific evidence on the potential of spectral computed tomography (SCT) for differentiation of nodules in the cirrhotic liver. We aimed to assess SCT-generated material density (MD) parameters for nodule characterisation in cirrhosis. Methods Dynamic dual-energy SCT scans of cirrhotic patients performed over 3 years were retrospectively reviewed. They were classified as hepatocellular carcinoma (HCC), regenerative or indeterminate, according to the European Association for the Study of the Liver criteria. MD maps were generated to calculate the area under the curve (AUC) and cutoff values to discriminate these nodules in the hepatic arterial phase (HAP) and portal venous phase (PVP). MD maps included iodine concentration density (ICD) of the liver and nodule, lesion-to-normal liver ICD ratio (LNR) and difference in nodule ICD between HAP and PVP. Results Three hundred thirty nodules belonging to 300 patients (age 53.0 ± 12.7 years, mean ± standard deviation) were analysed at SCT (size 2.3 ± 0.8 cm, mean ± SD). One hundred thirty-three (40.3%) nodules were classified as HCC, 147 (44.5%) as regenerative and 50 (15.2%) as indeterminate. On histopathology, 136 (41.2%) nodules were classified as HCC, 183 (55.5%) as regenerative and 11 (3.3%) as dysplastic. All MD parameters on HAP and the nodule difference in ICD could discriminate pathologically proven HCC or potentially malignant nodules from regenerative nodules (p < 0.001). The AUC was 82.4% with a cutoff > 15.5 mg/mL for nodule ICD, 81.3% > 1.8 for LNR-HAP and 81.3% for difference in ICD > 3.5 mg/mL. Conclusion SCT-generated MD parameters are viable diagnostic tools for differentiating malignant or potentially malignant from benign nodules in the cirrhotic liver. Supplementary Information The online version contains supplementary material available at 10.1186/s41747-021-00220-6.
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Affiliation(s)
- Shalini Thapar Laroia
- Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India.
| | - Komal Yadav
- Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India
| | - Senthil Kumar
- Department of HPB Surgery and Liver Transplantation, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India
| | - Archana Rastogi
- Department of Clinical and Hepato-pathology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India
| | - Guresh Kumar
- Department of Biostatistics and Research, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India
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Cruz-Hernández E, Mahmood U, Golia Pernicka JS, Paroder V, Petkovska I, Gollub MJ, Shia J, Ganesh K, Bates DDB. Initial evaluation of dual-energy computed tomography as an imaging biomarker for hepatic metastases from neuroendocrine tumor of the gastrointestinal tract. Quant Imaging Med Surg 2021; 11:2085-2092. [PMID: 33936989 DOI: 10.21037/qims-20-917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background To evaluate quantitative iodine parameters from the arterial phase dual-energy computed tomography (DECT) scans as an imaging biomarker for tumor grade (TG), mitotic index (MI), and Ki-67 proliferation index of hepatic metastases from neuroendocrine tumors (NETs) of the gastrointestinal (GI) tract. Imaging biomarkers have the potential to provide relevant clinical information about pathologic processes beyond lesion morphology. NETs are a group of rare, heterogeneous neoplasms classified by World Health Organization (WHO) TG, which is derived from MI and Ki-67 proliferation index. Imaging biomarkers for these pathologic features and TG may be useful. Methods Between January 2014 and April 2019, 73 unique patients with hepatic metastases from NET of the GI tract underwent DECT of the abdomen with an arterial phase were analyzed after exclusions. Using GSIViewer software (GE Healthcare, Madison, Wisconsin), elliptical regions of interest (ROIs) were placed over selected hepatic metastases by a fellowship trained abdominal radiologist. Quantitative iodine concentration (IC) data was extracted from the lesion ROIs, and the normalized IC (lesion IC/aorta IC) and relative IC (lesion IC/liver IC) for each liver were calculated. Spearman correlation was calculated for lesion mean IC, normalized IC, and relative IC to both Ki-67 proliferation and mitotic indices. Student's t-test was performed to compare lesion mean IC, normalized IC and relative IC between WHO TGs. Results There was very weak correlation between both normalized IC and relative IC for both Ki-67 proliferation and mitotic indices. A significant difference was not observed between normalized IC and relative IC to distinguish metastases from G1 and G2/3 tumors. Conclusions Our study finds limited potential for quantitative parameters from DECT to distinguish neuroendocrine hepatic metastases by WHO TG, as well as limited potential as an imaging biomarker for Ki-67 proliferation and mitotic indices in this setting. Our findings of a lack of correlation between Ki-67 and quantitative iodine parameters stands in contrast to existing literature that reports positive correlations for these parameters in the rectum and stomach.
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Affiliation(s)
| | - Usman Mahmood
- Department of Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karuna Ganesh
- Molecular Pharmacology Program and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Wang X, Liu D, Zeng X, Jiang S, Li L, Yu T, Zhang J. Dual-energy CT quantitative parameters for the differentiation of benign from malignant lesions and the prediction of histopathological and molecular subtypes in breast cancer. Quant Imaging Med Surg 2021; 11:1946-1957. [PMID: 33936977 DOI: 10.21037/qims-20-825] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Dual-energy computed tomography (DECT) is widely used to characterize and differentiate tumors. However, data regarding its diagnostic performance for the characterization of breast tumors are limited. In this study, we assessed the diagnostic performance of quantitative parameters derived from DECT in differentiating benign from malignant lesions and predicting histopathological and molecular subtypes in patients with breast cancer. Methods Dual-phase contrast-enhanced DECT of the thorax was performed on participants with breast tumors. Conventional CT attenuation and DECT quantitative parameters, including normalized iodine concentration (NIC), the slope of the spectral Hounsfield unit curve (λHu), and normalized effective atomic number (nZeff), were obtained and compared between benign and malignant lesions, invasive non-special carcinoma, and ductal carcinoma in situ (DCIS), and among the four molecular subtypes of breast cancer. The diagnostic performance of the quantitative parameters was analyzed using receiver operating characteristic (ROC) curves. Results This study included 130 participants with 161 breast lesions (44 benign and 117 malignant). In the arterial and venous phase, NICs, λHu, nZeff, and attenuation were higher in malignant lesions than benign lesions (all P<0.001). The venous phase λHu had the best differential diagnostic capability, with an area under the curve (AUC) of 0.90, a sensitivity of 84.1% (37 of 44), a specificity of 86.3% (101 of 117), and an accuracy of 85.7% (138 of 161). The NICs in the arterial and venous phases were higher in invasive non-special carcinoma than DCIS (both P<0.001). In terms of diagnostic performance, NIC in the venous phase had an AUC of 0.77, a sensitivity of 75.0% (12 of 16), a specificity of 81.2% (82 of 101), and an accuracy of 80.3% (94 of 117). The luminal A subtype produced a lower venous phase NIC, and arterial and venous phase nZeff than the non-luminal A subtype (AUC of 0.91 for the combination of these three parameters). Conclusions Dual-energy CT quantitative parameters are a feasible and valuable noninvasive means of differentiating between benign and malignant lesions, and predicting histopathological and molecular subtypes in patients with breast cancer.
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Affiliation(s)
- Xiaoxia Wang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Xiangfei Zeng
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Shixi Jiang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Lan Li
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Tao Yu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
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Birnbacher L, Braig EM, Pfeiffer D, Pfeiffer F, Herzen J. Quantitative X-ray phase contrast computed tomography with grating interferometry : Biomedical applications of quantitative X-ray grating-based phase contrast computed tomography. Eur J Nucl Med Mol Imaging 2021; 48:4171-4188. [PMID: 33846846 PMCID: PMC8566444 DOI: 10.1007/s00259-021-05259-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022]
Abstract
The ability of biomedical imaging data to be of quantitative nature is getting increasingly important with the ongoing developments in data science. In contrast to conventional attenuation-based X-ray imaging, grating-based phase contrast computed tomography (GBPC-CT) is a phase contrast micro-CT imaging technique that can provide high soft tissue contrast at high spatial resolution. While there is a variety of different phase contrast imaging techniques, GBPC-CT can be applied with laboratory X-ray sources and enables quantitative determination of electron density and effective atomic number. In this review article, we present quantitative GBPC-CT with the focus on biomedical applications.
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Affiliation(s)
- Lorenz Birnbacher
- Physics Department, Munich School of Bioengineering, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Eva-Maria Braig
- Physics Department, Munich School of Bioengineering, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Physics Department, Munich School of Bioengineering, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Herzen
- Physics Department, Munich School of Bioengineering, Technical University of Munich, Munich, Germany.
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Kang HJ, Lee DH, Park SJ, Han JK. Virtual noncontrast images derived from dual-energy CT for assessment of hepatic steatosis in living liver donors. Eur J Radiol 2021; 139:109687. [PMID: 33836335 DOI: 10.1016/j.ejrad.2021.109687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE This study aimed to investigate the correlation of attenuation between virtual noncontrast (VNC) and true noncontrast (TNC) CT images and compare the diagnostic performance for hepatic steatosis using MR spectroscopy (MRS) as the reference standard. METHODS A total of 131 consecutive hepatic donor candidates who underwent dual-source dual-energy CT and MRS within one month from January 2018 to April 2019 were included. An MRS value > 5.8 % was regarded as substantial hepatic steatosis. The correlation of attenuation between TNC and VNC in the liver and spleen, and liver attenuation index (LAI), defined as hepatic minus splenic attenuation, was evaluated using Spearman's rank correlation. The diagnostic performance of the LAI for hepatic steatosis was compared using receiver operating characteristic analyses. RESULTS Twenty-three candidates (17.6 %) had substantial hepatic steatosis. The median liver attenuation (66.7 [IQR, 63.5-70.9] vs. 63.5 [IQR, 60.3-66.9], p < .001) and LAI (12.9 [9.3-16.7] vs. 7.4 [3.9-11.9], p < .001) in the VNC were higher than those in the TNC. Hepatic attenuation (r = 0.93, p < .001), splenic attenuation (r = 0.55, p < .001), and LAI (r = 0.87, p < .001) were significantly correlated between TNC and VNC. Area under the curve of LAI in TNC and VNC were 0.88 (cutoff, LAI < 3.1) and 0.84 (cutoff, LAI < 10.1), respectively, indicating no statistically significant difference (p = 0.11). CONCLUSION The LAI of VNC is significantly correlated with that of TNC and might be feasible for diagnosing substantial hepatic steatosis in living liver donor candidates using different cutoff values of LAI.
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Affiliation(s)
- Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea.
| | - Sae Jin Park
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
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Spectral CT in clinical routine imaging of neuroendocrine neoplasms. Clin Radiol 2021; 76:348-357. [PMID: 33610290 DOI: 10.1016/j.crad.2020.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022]
Abstract
AIM To evaluate the potential of new spectral computed tomography (SCT)-based tools in patients with neuroendocrine neoplasms (NEN). MATERIAL AND METHODS Eighty-eight consecutive patients with NENs were included prospectively. The patients underwent multiphase CT with spectral and standard mode. The signal-to-noise ratio (SNR)/contrast-to-noise-ratio (CNR)tumour-to-liver, iodine concentrations (ICs, total tumour/hotspot) and attenuation slopes in virtual monochromatic images (VMIs) were used to assess NEN-specific SCT values in primary tumours and metastatic lesions and investigate a possible lesion contrast improvement as well as possible correlations of SCT parameters to primary tumour location and tumour grade. Furthermore, the usability of SCT parameters to differentiate between the primary tumour and metastatic lesions, and to predict tumour response after 6-months follow-up was analyzed. The applied dose of spectral and standard mode was compared intra-individually. RESULTS SNR/CNRtumour-to-liver significantly increased in low-energy VMIs. NENs showed significant differences in ICs between primary and metastatic lesions for both absolute and normalised values (p<0.001) regardless of whether the total tumour or the hotspot was measured. There was also a significant difference in the attenuation slope (p<0.001). No significant correlations were found between SCT and tumour grade. A tumour response prediction by SCT parameters was not possible. The applied dose was comparable between the scan modes. CONCLUSION SCT was comparable regarding applied dose, improved tumour contrast, and contributed to differentiation between primary NEN and metastasis.
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Wang X, Liu D, Zeng X, Jiang S, Li L, Yu T, Zhang J. Dual-energy CT quantitative parameters for evaluating Immunohistochemical biomarkers of invasive breast cancer. Cancer Imaging 2021; 21:4. [PMID: 33413654 PMCID: PMC7791709 DOI: 10.1186/s40644-020-00370-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 12/11/2020] [Indexed: 11/14/2022] Open
Abstract
Background Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki67 are the most useful immunohistochemical biomarkers of invasive breast cancer. The purpose of this study is to investigate the possibility of quantitative parameters derived from dual-energy CT (DECT) to discriminate immunohistochemical biomarkers of invasive breast cancer. Methods This prospective study enrolled 120 patients with invasive breast cancer who underwent preoperative contrast-enhanced DECT for staging purposes from June 2019 to January 2020. DECT quantitative parameters, including normalized iodine concentration (NIC), the slope of the spectral Hounsfield unit curve (λHu), and the normalized effective atomic number (nZeff), were obtained from reconstructed images. DECT quantitative parameters were compared with the expression status, and the correlations with the value of immunohistochemical biomarkers were evaluated. Inter-observer reproducibility analysis was performed to assess the measurement reproducibility of quantitative parameters. The diagnostic performance of the quantitative parameters was analyzed by receiver operating characteristic curve. Results The ER-negative group tended to display higher venous phase NIC and nZeff compared with the ER-positive group (individually, p = 0.003, 0.011; area under the curve [AUC] of 0.65, 0.60). The PR-negative group demonstrated higher arterial and venous phase NIC compared with the PR-positive group (individually, p = 0.022, 0.005; AUC of 0.63, 0.65). NIC was correlated negatively with the value of ER and PR expression (r = − 0.175 ~ − 0.265, p = 0.002 ~ 0.042). The HER2-positive group tended to display higher venous phase nZeff than the HER2-negative group (p = 0.022; AUC of 0.59). The Ki67 high-proliferation group demonstrated higher arterial phase, venous phase NIC and nZeff than the Ki67 low-proliferation group (p < 0.001 ~ 0.005; AUC of 0.67 ~ 0.75). Both the NIC and nZeff were correlated positively with the value of Ki67 (r = 0.240 ~ 0.490, p < 0.001 ~ 0.014). Conclusions NIC and nZeff derived from DECT could be used to discriminate expression status and may associate with the value of immunohistochemical biomarkers of invasive breast cancer.
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Affiliation(s)
- Xiaoxia Wang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, 400030, People's Republic of China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, 400030, People's Republic of China
| | - Xiangfei Zeng
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, 400030, People's Republic of China
| | - Shixi Jiang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, 400030, People's Republic of China
| | - Lan Li
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, 400030, People's Republic of China
| | - Tao Yu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, 400030, People's Republic of China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, 400030, People's Republic of China.
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Ji X, Zhang R, Li K, Chen GH. Dual Energy Differential Phase Contrast CT (DE-DPC-CT) Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:3278-3289. [PMID: 32340940 PMCID: PMC7584735 DOI: 10.1109/tmi.2020.2990347] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
When more than two elemental materials are present in a given object, material quantification may not be robust and accurate when the routine two-material decomposition scheme in current dual energy CT imaging is employed. In this work, we present an innovative scheme to accomplish accurate three-material decomposition with measurements from a dual energy differential phase contrast CT (DE-DPC-CT) acquisition. A DE-DPC-CT system was constructed using a grating interferometer and a photon counting CT imaging system with two energy bins. The DE-DPC-CT system can simultaneously measure both the imaginary and the real part of the complex refractive index to enable a three-material decomposition. Physical phantom with 21 material inserts were constructed and measured using DE-DPC-CT system. Results demonstrated excellent accuracy in elemental material quantification. For example, relative root-mean-square errors of 4.5% for calcium and 5.2% for iodine were achieved using the proposed three-material decomposition scheme. Biological tissues with iodine inserts were used to demonstrate the potential utility of the proposed spectral CT imaging method. Experimental results showed that the proposed method correctly differentiates the bony structure, iodine, and the soft tissue in the biological specimen samples. A triple spectra CT scan was also performed to benchmark the performance of the DE-DPC-CT scan. Results demonstrated that the material decomposition from the DE-DPC-CT has a much lower quantification noise than that from the triple spectra CT scan.
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Zopfs D, Graffe J, Reimer RP, Schäfer S, Persigehl T, Maintz D, Borggrefe J, Haneder S, Lennartz S, Große Hokamp N. Quantitative distribution of iodinated contrast media in body computed tomography: data from a large reference cohort. Eur Radiol 2020; 31:2340-2348. [PMID: 32997173 PMCID: PMC7979665 DOI: 10.1007/s00330-020-07298-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/27/2020] [Accepted: 09/15/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Dual-energy computed tomography allows for an accurate and reliable quantification of iodine. However, data on physiological distribution of iodine concentration (IC) is still sparse. This study aims to establish guidance for IC in abdominal organs and important anatomical landmarks using a large cohort of individuals without radiological tumor burden. METHODS Five hundred seventy-one oncologic, portal venous phase dual-layer spectral detector CT studies of the chest and abdomen without tumor burden at time point of imaging confirmed by > 3-month follow-up were included. ROI were placed in parenchymatous organs (n = 25), lymph nodes (n = 6), and vessels (n = 3) with a minimum of two measurements per landmark. ROI were placed on conventional images and pasted to iodine maps to retrieve absolute IC. Normalization to the abdominal aorta was conducted to obtain iodine perfusion ratios. Bivariate regression analysis, t tests, and ANOVA with Tukey-Kramer post hoc test were used for statistical analysis. RESULTS Absolute IC showed a broad scatter and varied with body mass index, between different age groups and between the sexes in parenchymatous organs, lymph nodes, and vessels (range 0.0 ± 0.0 mg/ml-6.6 ± 1.3 mg/ml). Unlike absolute IC, iodine perfusion ratios did not show dependency on body mass index; however, significant differences between the sexes and age groups persisted, showing a tendency towards decreased perfusion ratios in elderly patients (e.g., liver 18-44 years/≥ 64 years: 0.50 ± 0.11/0.43 ± 0.10, p ≤ 0.05). CONCLUSIONS Distribution of IC obtained from a large-scale cohort is provided. As significant differences between sexes and age groups were found, this should be taken into account when obtaining quantitative iodine concentrations and applying iodine thresholds. KEY POINTS • Absolute iodine concentration showed a broad variation and differed between body mass index, age groups, and between the sexes in parenchymatous organs, lymph nodes, and vessels. • The iodine perfusion ratios did not show dependency on body mass index while significant differences between sexes and age groups persisted. • Provided guidance values may serve as reference when aiming to differentiate healthy and abnormal tissue based on iodine perfusion ratios.
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Affiliation(s)
- David Zopfs
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany
| | - Josefine Graffe
- Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Robert Peter Reimer
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany
| | | | - Thorsten Persigehl
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany
| | - David Maintz
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany
| | - Jan Borggrefe
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany
| | - Stefan Haneder
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany
| | - Simon Lennartz
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nils Große Hokamp
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany.
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Lenga L, Lange M, Arendt CT, Booz C, Yel I, Bodelle B, D'Angelo T, Hammerstingl RM, Huizinga NA, Vogl TJ, Martin SS, Albrecht MH. Measurement Reliability and Diagnostic Accuracy of Virtual Monoenergetic Dual-Energy CT in Patients with Colorectal Liver Metastases. Acad Radiol 2020; 27:e168-e175. [PMID: 31727567 DOI: 10.1016/j.acra.2019.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES To compare dual-energy CT virtual monoenergetic images (VMI) and standard reconstructions for reliability of quantitative size measurements and diagnostic accuracy for the detection of colorectal liver metastases (CRLM). MATERIALS AND METHODS We retrospectively included 98 patients (mean age, 61.1±11.5 years) with colorectal cancer, of whom 49 subjects had CRLM. All patients underwent a portal-venous phase dual-energy CT examination. Standard linearly-blended reformats and 40-keV VMI were reconstructed. For both reconstruction techniques, two blinded readers performed measurements of CRLM twice in a preset sequence. Three additional radiologists independently assessed all liver lesions in terms of dignity (benign vs. malignant). Sensitivity, specificity and diagnostic accuracy were calculated on a per-patient basis using MRI as reference standard. Readers scored the suitability for metric measurements and their diagnostic confidence using 5-point Likert scales. Inter-rater agreement was evaluated using intraclass correlation coefficient (ICC). RESULTS Inter-rater agreement for lesion size measurements was higher for 40-keV VMI (ICC, 0.88) compared to standard linearly-blended series (ICC, 0.80). Sensitivity and diagnostic accuracy for the detection of CRLM were significantly higher for VMI at 40-keV compared to standard reconstructions (90.6% vs. 80.6%, and 89.1% vs. 81.3%; p < 0.001). Reader scores indicated that 40-keV VMI were more suitable for metric lesion measurements and provided greater diagnostic confidence compared to standard reformats (median, 5 vs. 3, and 5 vs. 4; both p < 0.001). CONCLUSION Low-keV VMI reconstructions improve reliability of quantitative size measurements and diagnostic accuracy for the assessment of CRLM compared to standard linearly-blended images.
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Bird JR, Brahm GL, Fung C, Sebastian S, Kirkpatrick IDC. Recommendations for the Management of Incidental Hepatobiliary Findings in Adults: Endorsement and Adaptation of the 2017 and 2013 ACR Incidental Findings Committee White Papers by the Canadian Association of Radiologists Incidental Findings Working Group. Can Assoc Radiol J 2020; 71:437-447. [DOI: 10.1177/0846537120928349] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The Canadian Association of Radiologists Incidental Findings Working Group consists of both academic subspecialty and general radiologists and is tasked with adapting and expanding upon the American College of Radiology incidental findings white papers to more closely apply to Canadian practice patterns, particularly more comprehensively dealing with the role of ultrasound and pursuing more cost-effective approaches to the workup of incidental findings without compromising patient care. Presented here are the 2020 Canadian guidelines for the management of hepatobiliary incidental findings. Topics covered include initial assessment of hepatic steatosis and cirrhosis, the workup of incidental liver masses identified on ultrasound and computed tomography (with algorithms presented), incidental gallbladder findings (wall thickening, calcification, and polyps), and management of incidental biliary dilatation.
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Affiliation(s)
- Jeffery R. Bird
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gary L. Brahm
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Christopher Fung
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Sunit Sebastian
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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Semiautomatic Segmentation and Radiomics for Dual-Energy CT: A Pilot Study to Differentiate Benign and Malignant Hepatic Lesions. AJR Am J Roentgenol 2020; 215:398-405. [PMID: 32406776 DOI: 10.2214/ajr.19.22164] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE. This study assessed a machine learning-based dual-energy CT (DECT) tumor analysis prototype for semiautomatic segmentation and radiomic analysis of benign and malignant liver lesions seen on contrast-enhanced DECT. MATERIALS AND METHODS. This institutional review board-approved study included 103 adult patients (mean age, 65 ± 15 [SD] years; 53 men, 50 women) with benign (60/103) or malignant (43/103) hepatic lesions on contrast-enhanced dual-source DECT. Most malignant lesions were histologically proven; benign lesions were either stable on follow-up CT or had characteristic benign features on MRI. Low- and high-kilovoltage datasets were deidentified, exported offline, and processed with the DECT tumor analysis for semiautomatic segmentation of the volume and rim of each liver lesion. For each segmentation, contrast enhancement and iodine concentrations as well as radiomic features were derived for different DECT image series. Statistical analyses were performed to determine if DECT tumor analysis and radiomics can differentiate benign from malignant liver lesions. RESULTS. Normalized iodine concentration and mean iodine concentration in the benign and malignant lesions were significantly different (p < 0.0001-0.0084; AUC, 0.695-0.856). Iodine quantification and radiomic features from lesion rims (AUC, ≤ 0.877) had higher accuracy for differentiating liver lesions compared with the values from lesion volumes (AUC, ≤ 0.856). There was no difference in the accuracies of DECT iodine quantification (AUC, 0.91) and radiomics (AUC, 0.90) for characterizing liver lesions. CONCLUSION. DECT radiomics were more accurate than iodine quantification for differentiating solid benign and malignant hepatic lesions.
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Böning G, Jahnke P, Feldhaus F, Fehrenbach U, Kahn J, Hamm B, Streitparth F. Stepwise analysis of potential accuracy-influencing factors of iodine quantification on a fast kVp-switching second-generation dual-energy CT: from 3D-printed phantom to a simple solution in clinical routine use. Acta Radiol 2020; 61:424-431. [PMID: 31319686 DOI: 10.1177/0284185119861312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Measurement of iodine concentration from dual-energy or spectral computed tomography (CT) provides useful diagnostic information especially in patients suffering from malignant tumors of various origins. Purpose The purpose of this study was to systematically investigate the accuracy of the measurement of iodine concentration, focusing on potential influencing factors and assessing its suitability for routine clinical use. Material and Methods First, a 3D-printed cylindrical phantom was used to assess reliability of dual-energy CT-based iodine concentration measurement. Second, a semi-anthropomorphic phantom was used to evaluate the potential impact of positional variation of the target volume as typically seen in clinical scans. Finally, a reference vial was placed on the body surface of 38 patients undergoing abdominal dual-energy CT to analyze correlations between applied doses and patient diameters. Results The position of the target volume within the cylindrical phantom and the applied dose level significantly influenced the magnitude of measured iodine concentrations ( P < 0.001). We also found a significant difference in accuracy depending on target volume position in the semi-anthropomorphic phantom ( P = 0.028). In patient scans, we observed an error of 19.6 ± 5.6% in iodine concentration measurements of a reference and significant, moderate to strong, negative correlations between measured iodine concentration, maximum patient diameter, and applied dose (maximum sagittal diameter: r = −0.455, P = 0.004; maximum coronal diameter: r=−0.517, P = 0.001; CTDIvol: r = −0.385, P = 0.017) Conclusion Dual-energy CT-based iodine concentration measurement should be interpreted with caution. In clinical examinations, placement of a reference vial could be a potential solution to relativize errors.
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Affiliation(s)
- Georg Böning
- Department of Radiology, Charité – Universitätsmedizin Berlin, Humboldt University and Free University of Berlin Medical School, Berlin, Germany
| | - Paul Jahnke
- Department of Radiology, Charité – Universitätsmedizin Berlin, Humboldt University and Free University of Berlin Medical School, Berlin, Germany
| | - Felix Feldhaus
- Department of Radiology, Charité – Universitätsmedizin Berlin, Humboldt University and Free University of Berlin Medical School, Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité – Universitätsmedizin Berlin, Humboldt University and Free University of Berlin Medical School, Berlin, Germany
| | - Johannes Kahn
- Department of Radiology, Charité – Universitätsmedizin Berlin, Humboldt University and Free University of Berlin Medical School, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité – Universitätsmedizin Berlin, Humboldt University and Free University of Berlin Medical School, Berlin, Germany
| | - Florian Streitparth
- Department of Radiology, Charité – Universitätsmedizin Berlin, Humboldt University and Free University of Berlin Medical School, Berlin, Germany
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Barachini O, Bernt R, Mirzaei S, Pirich C, Hergan K, Zandieh S. The impact of 18F-FDOPA-PET/MRI image fusion in detecting liver metastasis in patients with neuroendocrine tumors of the gastrointestinal tract. BMC Med Imaging 2020; 20:22. [PMID: 32093632 PMCID: PMC7038547 DOI: 10.1186/s12880-020-00424-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/11/2020] [Indexed: 12/16/2022] Open
Abstract
Background This study assesses the value of image fusion using 18F-fluoro-L-DOPA (18F-DOPA) positron emission tomography (PET) and magnetic resonance imaging (MRI) for examining patients with neuroendocrine tumors (NETs) and a suspicion of metastasis of the liver. Methods Eleven patients (five women and six men aged between 20 and 81, with a mean age of 54.6 years) were included in the study. All patients underwent whole-body 18F-DOPA PET examinations and contrast-enhanced MRI with diffusion-weighted sequences (DWS). Image fusion was performed using a semiautomatic voxel-based algorithm. Images obtained using PET and MRI were assessed separately. Side-by-side evaluations of fused PET/MRI images were also performed. Results In total, 55 liver lesions (52 liver metastases and 3 benign lesions) were detected in the 11 patients. Sensitivity detection for liver lesions was higher when using PET/CT than when using contrast-enhanced MRI without DWSs and lower than using MRI with DWSs. The sensitivity of PET/MRI image fusion in the detection of liver metastasis was significantly higher than that of MRI with DWSs (P < 0.05). Conclusion Images of the liver obtained using PET and MRI in patients with NETs exhibited characteristic features. These findings suggest that an appropriate combination of available imaging modalities can optimize patient evaluations.
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Affiliation(s)
- O Barachini
- Institute of Radiology and Nuclear Medicine, Hanusch-Hospital, Heinrich-Collin-Strasse 30, A-1140, Vienna, Austria
| | - R Bernt
- Institute of Radiology and Nuclear Medicine, Hanusch-Hospital, Heinrich-Collin-Strasse 30, A-1140, Vienna, Austria
| | - S Mirzaei
- Department of Nuclear Medicine with PET-Center, Wilhelminen-Hospital, Vienna, Austria
| | - C Pirich
- Department of Nuclear Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - K Hergan
- Department of Radiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - S Zandieh
- Institute of Radiology and Nuclear Medicine, Hanusch-Hospital, Heinrich-Collin-Strasse 30, A-1140, Vienna, Austria. .,Department of Radiology, Paracelsus Medical University of Salzburg, Salzburg, Austria.
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Atwi NE, Sabottke CF, Pitre DM, Smith DL, Danrad R, Dharaiya E, Kambadakone A, Pandharipande PV, Toshav AM. Follow-up Recommendation Rates Associated With Spectral Detector Dual-Energy CT of the Abdomen and Pelvis: A Retrospective Comparison to Single-Energy CT. J Am Coll Radiol 2020; 17:940-950. [PMID: 32032553 DOI: 10.1016/j.jacr.2019.12.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/28/2019] [Accepted: 12/30/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dual-energy CT image sets have many applications in abdominopelvic imaging but no demonstrated clinical effect. PURPOSE To determine the effect of dual-energy CT iodine maps on abdominopelvic imaging follow-up recommendation rates. MATERIALS AND METHODS Retrospective study of abdominopelvic CTs acquired from April 2017 through June 2018. CT reports were analyzed for radiologic follow-up recommendation and follow-up recommendation reason. Follow-up MRI reports were analyzed for benign or nonbenign diagnosis. CT scans with iodine maps (CTIMs) and conventional CT scans (CCTs) subgroups were compared using χ2 testing. RESULTS In all, 3,221 abdominopelvic CT scans of 2,401 patients (1,326 men, 1,075 women, mean age 54.1 years) were analyzed; 1,423 were CTIMs and 1,798 were CCTs. Follow-up recommendation rates were not significantly different for CTIMs and CCTs (19.5% and 21.4%, respectively, P = .19). Follow-up recommendations because of incomplete diagnosis were significantly lower in CTIMs (9.1%) than in CCTs (11.9%, P = .01). Follow-up recommendations for MRI and PET/CT were significantly lower in CTIMs (9.6%) than CCTs (13.0%, P = .003). Follow-up MRI outcomes (n = 111) were not different between CTIMs (61.2% benign) and CCTs (59.6%, P = .87). CONCLUSION Dual-energy CT iodine maps are associated with decreased follow-up examinations because of incomplete diagnosis and decreased recommendations for follow-up MRI, suggesting that abdominopelvic iodine maps may benefit patient care and decrease institutional cost.
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Affiliation(s)
- Noah E Atwi
- Department of Radiology, LSU Health Sciences Center New Orleans, New Orleans, Louisiana
| | - Carl F Sabottke
- School of Medicine, LSU Health Sciences Center New Orleans, New Orleans, Louisiana
| | - David M Pitre
- School of Medicine, LSU Health Sciences Center New Orleans, New Orleans, Louisiana
| | - David L Smith
- Department of Radiology, LSU Health Sciences Center New Orleans, New Orleans, Louisiana
| | - Raman Danrad
- Clinical Director of MRI, Academic Director of Cardiac Imaging, Department of Radiology, LSU Health Sciences Center New Orleans, New Orleans, Louisiana
| | - Ekta Dharaiya
- Head of CT Clinical Marketing, Philips Healthcare, Cleveland, Ohio
| | - Avinash Kambadakone
- Medical Director, Martha's Vineyard Hospital Imaging, Chief of CT, Massachusetts General Hospital, Boston, Massachusetts
| | - Pari V Pandharipande
- Director, MGH Institute for Technology Assessment; Associate Chair, Integrated Imaging & Imaging Sciences, MGH Radiology; Executive Director, Clinical Enterprise Integration, Mass General Brigham (MGB) Radiology; Associate Professor of Radiology Harvard Medical School; Radiologist, Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts
| | - Aran M Toshav
- Program Director of the diagnostic residency, Department of Radiology, LSU Health Sciences Center, New Orleans, Louisiana.
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Zhang C, Wang N, Su X, Li K, Yu D, Ouyang A. FORCE dual-energy CT in pathological grading of clear cell renal cell carcinoma. Oncol Lett 2019; 18:6405-6412. [PMID: 31807164 PMCID: PMC6876341 DOI: 10.3892/ol.2019.11022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 09/06/2019] [Indexed: 12/16/2022] Open
Abstract
The aim of the present study was to examine the value of FORCE dual-energy CT in grading the clear cell renal cell carcinoma (ccRCC). A total of 35 cases of ccRCC were included. Hematoxylin and eosin staining was performed, and the cases were divided into low- (Fuhrman I-II) and high-grade (Fuhrman III-IV) groups. FORCE dual-energy CT parameters, including virtual network computing CT value (VNCV), iodine overlay value (IOV), mixed energy CT value (MEV), iodine concentration (IC), normalized iodine concentration (NIC), NIC based on aorta (NICA), NIC based on cortex (NICC) and NIC based on medulla (NICM), were analyzed and compared. Receiver operating characteristic analysis was also performed. There were significant differences in the arterial phase IOV, MEV and IC, and the venous phase IOV and IC between the low- and high-grade groups. No significant differences were observed in VNCV and MEV between the low -and high-grade groups in the venous phase. Significant differences were observed in the NICA and NICC between these two groups, however no difference was observed in NICM. There were significant differences in the tumor CT values for the arterial phase at the 40, 60, 80 and 100 kiloelectron volt (keV) between the low- and high-grade groups, while no significant differences were observed at the 120-140 keV levels. The k-slope for the low-grade group was significantly higher than the high-grade group. In addition, the area under curve for the arterial phase IOV, arterial phase MEV, arterial phase IC, aortic NIC, cortical NIC, venous phase IOV, venous phase IC and curve slope K of mono-energy CT value suggested high value in diagnosis of low- and high-grade ccRCC cases.
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Affiliation(s)
- Chunling Zhang
- Department of Radiology, Jinan Central Hospital, Shandong University, Jinan, Shandong 250013, P.R. China
| | - Ning Wang
- Department of Radiology, Jinan Central Hospital, Shandong University, Jinan, Shandong 250013, P.R. China
| | - Xinyou Su
- Department of Oncology, Jinan Central Hospital, Shandong University, Jinan, Shandong 250013, P.R. China
| | - Kun Li
- Department of Radiology, Jinan Central Hospital, Shandong University, Jinan, Shandong 250013, P.R. China
| | - Dexin Yu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Aimei Ouyang
- Department of Radiology, Jinan Central Hospital, Shandong University, Jinan, Shandong 250013, P.R. China
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How accurate and precise are CT based measurements of iodine concentration? A comparison of the minimum detectable concentration difference among single source and dual source dual energy CT in a phantom study. Eur Radiol 2018; 29:2069-2078. [DOI: 10.1007/s00330-018-5736-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/09/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
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